Provider Demographics
NPI:1952684458
Name:ROSEBORROUGH, AIMEE (PT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:ROSEBORROUGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:LOEWENSTERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:61615 ATHLETIC CLUB DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3247
Practice Address - Country:US
Practice Address - Phone:541-382-7890
Practice Address - Fax:541-382-7498
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500639251Medicaid
ORR161513Medicare PIN